Craig Cunningham/Daily MailGupta treats a patient at West Virginia Healthright Tuesday. He said he enjoys treating patients on a volunteer basis at free clinics.

From the H1N1 flu outbreak to the MCHM tap water contamination, Dr. Rahul Gupta has faced some complex situations as the health officer and executive director of the Kanawha-Charleston Health Department.The challenges have been immense, but Dr. Gupta welcomes them."The things that get me going are the interesting problems," he said. "The more difficult the problem is, the more I like to tackle it. It's just nature."Gupta started his tenure in Charleston on March 16, 2009. Tomorrow marks his fifth year at the helm of the Kanawha-Charleston Health Department.

Gupta has been thrust into the spotlight recently as the Jan. 9 chemical leak that tainted the tap water flowing to 300,000 West Virginians garnered national attention. Gupta appeared on television nationally explaining the health risks associated with the chemical leak, but he became somewhat of a hero locally by erring on the side of caution early on during the crisis, even though state and federal officials often talked over him to say the water was safe."I think that goes back to his ability to look at the whole situation, find out the facts, and try to talk to people on their level," Kanawha-Charleston President Brenda Isaacs said. "This was a very difficult situation because no one knew what they were dealing with.Dr. Gupta was the first to admit we don't know what we're dealing with. This has not happened before and no one really knows what to do here. But I think he really listened to the people's concerns."The West Virginia Senate adopted a Senate Resolution 54 Saturday honoring Gupta for his work with the public after the chemical leak. Sen. John Unger said many people breathed easier during the crisis because of Gupta, and Sen. Evan Jenkins noted that public health officers are often overlooked and unsung heroes who struggle for funding.Gupta first became involved in public health while studying for his Doctor of Medicine degree at Delhi University in India. He volunteered in a 750-bed tuberculosis hospital where he saw polio and plague outbreaks firsthand."There was sort of a breadth, width and depth of public health that was sort of ingrained in me as part of what I did," Gupta said.After earning his degree in 1994 and completing specialized training on pulmonary medicine, Gupta moved to Chicago and began his residency at Saint Joseph Hospital. There, he continued volunteering at public health clinics in inner city Chicago until he earned his board certification in 1999."I've always done that, taken time out to volunteer, because it does give you a view into the real life, which is real people suffering real illnesses," Gupta said.Gupta's wife wanted a warmer place to live, so Gupta, his wife and kids moved to rural Alabama in 2000 where he went into private practice. In rural areas, Gupta said fewer resources are available to public health officials, so every doctor and pharmacist becomes a key player in public health."How you work is you network," Gupta said, explaining that pharmacists, doctors and nurses work together to find out the source of an outbreak of an illness.He also learned a grim reality about public health: there are often disconnects between public policy and the residents the policies are meant to protect.

"What was happening on the ground was I was seeing a lot of our senior folks having to choose between their medication costs and their food," Gupta said. "Medical school, wherever you are, doesn't teach you a whole lot about health systems. It doesn't teach you a whole lot about public health, generally speaking."
Gupta pursued his passion of public health in 2004 when he became an assistant professor at the University of Alabama-Birmingham and began studying for a Masters in Public Health (MPH) in Healthcare Organization and Health Policy. He earned his degree in three years while teaching full-time and keeping up with his private practice."I had two little kids and it was tough," Gupta said.He moved to Nashville in 2007 where he joined Meharry Medical College, a public hospital, as a professor, with a secondary appointment at Vanderbilt University. There, he said, he immersed himself in public health policy while still taking care of patients.He found out about the opening for the top job at Kanawha-Charleston in late 2008. Isaacs said two candidates, including Gupta, were interviewed, but Gupta was chosen because of his deep understanding of public health and the specific health issues West Virginia faces."I think it was his passion, the fact that he really wanted to do this," she said. "He actually took a small pay cut to come work with us because he really wanted to be on the local level doing public health.

"Because he had been a physician in private practice, he didn't see things from the ivory tower perspective. He actually knew what it was like to work with low income people and middle income people, and he saw things from the practical perspective," Isaacs said.Within a week on the job, a child died of the flu, and the next month, the H1N1 flu pandemic spread across the nation. Gupta and his colleagues went to work and formed the Kanawha County H1N1 Task Force. About 150 organizations and individuals teamed up to obtain a higher vaccine coverage in Kanawha County than at the state or federal levels. An in-school flu vaccine drive, which continues to this day, offered Kanawha County's 30,000 schoolchildren the H1N1 vaccine in 2009."There weren't a lot of protocols. There weren't a lot of written things you could just follow a particular procedure. You had to come up with stuff, and I think that's where this particular agency excels," Gupta said. "They came up with things, and as a result, we were able to process 250 people an hour in our clinics with shots."The school immunization program was such a great success, Gupta wanted to continue it after the H1N1 pandemic. The problem? H1N1 vaccines were free, but regular vaccines would cost money and the school immunization program had no funding.

Rather than absorb the costs of buying the flu shots, the health department bills each student's insurance provider.The idea makes sense, Gupta said, because if the health department buys a flu shot for someone who has insurance, "we are only subsidizing insurance companies and taking away money from taxpayers."Letters are sent home with schoolchildren, and parents can voluntarily write down their health insurance information so their child can be given the flu shot in an annual in-school flu immunization clinic.Gupta said 90 percent of parents provide their information.In 2011, the health department billed health insurance companies for 6,942 flu vaccines and received $84,000. The health department spent about $69,500 on the school flu clinics - $45,000 for vaccines, $18,000 for staff and $6,500 on supplies - and ended up with a surplus of $14,500.Year-after-year, the surpluses are enough to cover immunizations for children not covered by health insurance."Kids are the ones that transmit bugs, and the grandparents are the ones that get sick and are at risk of dying in a hospital," Gupta said. "If we can stop that transmission at the kid level, we can keep elderly people from having complications like the flu."Kanawha-Charleston won a model practice award from the National Association of County and City Health Officials in 2012 for its school immunization program, the highest award a public health department can receive. The department also received a model practice award the same year for its Clean Living Environment in Appalachian Neighborhoods - or CLEAN - initiative that banned smoking in public places, including bars and restaurants.Gupta said there has been a 37 percent reduction in heart attack cases at local hospitals since the smoking ban was enacted.Gupta has also overseen the combination of the Kanawha-Charleston and Putnam health departments. The Putnam County Health Department laid off its 14-person staff in June, 2013 amid financial problems. Kanawha-Charleston has provided clinical services for Putnam County since July 1, a move that has reduced expenses for Putanm County by about 40 percent, Gupta said Meanwhile, services have increased by 283 percent.The Freedom Industries chemical leak presents a unique challenge; more than 300,000 people may be affected by a chemical with little scientific data known about it, and a guaranteed funding source for long-term medical monitoring from the state or federal level is nowhere in sight."To me, it is a moral imperative that we do conduct long-term monitoring in our population," Gupta said. "There is no excuse for not doing it."The question becomes if we don't invest in this population surveillance and medical monitoring, if there is even a small, remote chance that people could get sick in the future, that could be a much more expensive proposition because we could have prevented that from happening," Gupta said."That's the moral imperative we all face. Some people are willing to live with it. People like me are not."Gupta criticized the lack of new scientific data produced in the nine weeks since the chemical spill, and said he will find funding for long-term medical monitoring however he can."This is so historic and unprecedented in the history of this nation, you have to wonder if there isn't a better way to do this type of work," Gupta said. "It's gotten me a lot of thought as to, 'is the best we can do?' A lot of times I think if this happened in any other country, and it was a chemical exposure of some kind, wouldn't we be calling them and saying 'Hey, you need to do something to protect your people.' I think we would be the first ones to do that as a nation, to call on the other country to fix their issues."There are countless other chemical tanks along other waterways in the country. Gupta worries that a bad precedent is being set here."History will be written, and it's up to people and those who have the power to make decisions (about) which side of history they want to be on," he said.Gupta says he understands the health department may not get the "Cadillac plan" from the government when it comes to long-term medical surveillance. He has accepted that, and has devoted resources to finding other funding sources."I've got our employees here and some leaders within the agency searching day and night to find those grants, to search them up, to make contacts and apply for them," Gupta said. "We're going to do it. We're not going to give up on the people."Gupta said he has had a "phenomenal" five years in Charleston, and his family has grown to love the city and state they live in. Aside from the two model practice awards, Gupta said Kanawha-Charleston is currently awaiting national accreditation from the Public Health Accreditation Board. The department became the first West Virginia public health department to apply for accreditation when it applied last year, and Gupta said he hopes Kanawha-Charleston can be nationally accredited by the end of this year.As Gupta begins his sixth year in Charleston, he plans to keep pushing the envelope of public health in Kanawha County."My challenge to folks is simple: lead, follow or get out of the way," Gupta said. "We are going to try to make (long-term medical surveillance) happen if others can't or won't or are unable to. There's no disrespect or critique of anybody, it's just that I've got to take care of our people."To me it's very simple. I'm in a position that I have taken an oath to do whatever I can to protect the people of this county and Putnam County, and that's what I am going to do."Contact writer Marcus Constantino at 304-348-1796 or marcus.c@dailymailwv.com. Follow him at www.twitter.com/amtino.